How Gadgets & Digital Screens Are Harming your Child’s Eyes

You are most probably reading this article from your phone, tablet or other digital device. Furthermore, if you are with young children, they probably have one in their hands too, be it a smartphone, tablets or laptops. The use of what we call gadgets are so prevalent in this day and age, that you no longer remember the time when pay- phones were the only way to communicate while travelling.

And then there is myopia. Myopia or short-sighted/near-sightedness is a significant global public health concern rising in importance since the last few decades. To quote some statistics from recently published research, myopia affects 85 to 90% of young adults in some Asian countries such as Singapore and Taiwan. In comparison, during the 1950’s, only 10–20% of the Chinese population was short-sighted. Today, up to 90% of Chinese teenagers and young adults have some form of myopia. Other parts of the world have also seen a dramatic increase in the condition, which now affects around half of young adults in the United States and Europe — double the prevalence of half a century ago. We are now seeing myopia or short-sightedness reaching epidemic proportions.

Clearly, there must be a correlation between excessive use of gadgets and global increase of myopia cases. No doubt, contact lenses, glasses or surgery can help to correct short-sightedness, but the underlying problem remains that myopia is caused by a slightly elongated eyeball. So, are smartphones and gadgets to blame for this? The short answer to that is yes.

BLURRED VISION

Viewing digital screens such as laptops or smartphones involve an active vision process to maintain a clear image, called accommodation. Accommodation is the mechanism where the eyes change focus from distant to near images by contracting the ciliary muscles, which allows the shape of the lens to be more rounded and hence allowing near image to focus on the retina, giving clear vision to the objects.

The eye accommodates for distance vision by relaxing the ciliary muscle, allowing the pliable lenses to become more elongated, and lead the incoming light to focus on the retina. Exposing our eyes to focus near objects for an extended period, such as reading from a smartphone, playing games using laptops or tablets, require the ciliary muscle to contract for a long time. When the ciliary muscle fails to relax when the eyes changing focus to a distance objects, this is called ‘Accommodation Spasm’. The distance objects will seem blurry, which leads to the occurrence of pseudo-myopia or false short-sightedness. Fortunately, this condition is temporary and will disappears after discontinuing the use of digital screens.

DRY EYES

When using gadgets and looking at digital screens, the eyes will focus to this near range object. As such, the eye blinking rate (BR) can reduce from resting BR of 15 per minute to about 5 per minute.

Furthermore, children who use gadgets may be utilizing adult size furniture. For example, using a laptop while sitting on a lower seating height adult chair will cause them to look up when viewing the screen, leading to a larger eyelid opening. This causes the rate of evaporation of tears to increase. A larger eyelid opening, combined with reduced amount of blinking to around 5 times per minute will result in dry points that can cause small lesions on the surface of the cornea, called superficial Punctate Epithelial Erosions (PEE). Some symptoms of the PEE include sense of dry eye, red eye, foreign body sensation, photophobia and burning sensation. Proper diagnosis, treatment, and prognosis of PEE can only be determined by an eye care professional. It may be treated with artificial tears or topical antibiotic eye drop.

PEE lesions on cornea surface seen under fluorescent light

INCREASED CASES OF MYOPIA (SHORT- SIGHTEDNESS)

Spending too much time indoors with a gadget will dissuade children from doing any outdoor physical activities. Studies have found that myopic children have lower levels of dopamine compared to children without any vision problem.

Dopamine is a chemical produced in the brain and acts as a neurotransmitter, also famously known as a feel-good hormone as it creates feeling of happiness and satisfaction. It is found that dopamine helps inhibit the elongation of the eyeball, which is the leading cause of myopia.

Low levels of dopamine relate to reduced motivation and decreased enthusiasm for things that would excite most people. Getting enough sunlight, doing adequate exercise and getting adequate amount of sleep has shown to increase the level of dopamine naturally.

EYE NERVE DAMAGE


Gadgets employ digital screens which produce blue light rays which in the visible light spectrum has the shortest wavelength but the highest energy. Although our cornea and lens are very effective at blocking UV rays from reaching the sensitive retina at the back of the eyeball, virtually all visible blue light passes through the cornea and lens and reaches the retina. Laboratory studies have shown that too much exposure to blue light can damage light-sensitive cells in the retina. This causes changes that resemble those of macular degeneration, which can lead to permanent vision loss.

My kids won’t stop using gadgets. So, what can we do to minimize potential damages to our children’s eyes?

20-20-20 Rule

Many kids spend a substantial period of time looking at smartphones and gadgets, which can lead to eye fatigue and neck strain. To prevent such occurrence, practise a 20-20-20 rule. Every 20 minutes, take 20-second break and focus your eyes on something at least 20 feet away. Frequent breaks while using digital devices can also prevent the occurrence of accommodation spasm or pseudo-myopia. Remind your children to blink frequently and fully while using their devices and use moisturising eye drop when their eyes feels dry.

Limit Exposure Time to Digital Screens

The American Academy of Paediatrics have provided a recommendation and guideline for media usage in children from birth to adulthood. Among its recommendations are:
• For children younger than 18 months old, avoid the use of digital screen other than video chatting.
• For children aged 2 to 5 years, limit digital screen use to 1 hour/day of high quality program.
• For children aged 6 and older, there should be consistent limit on the time spent using media, and the limit set must ensure adequate time is allocated for sleeping and physical exercise.

Encourage Outdoor Activities

It is a well-known fact that outdoor activities such as running, swimming, doing sports and camping keep us healthy, tightens bonds between family and most importantly distracts children from using their gadget. However, our busy schedule and our hot tropical climate will make daily exercise difficult. If this sounds familiar, allocate a period during weekends to exercise, or arrange activities that can be done together in a group, such as camping, participating in running events or hiking. Also, exposure to the morning sun encourage our body to produce more serotonin, a hormone that controls sleep/awake cycle and increases the level of dopamine produces by the body.

Correct Usage of Digital Device

If a digital device is an essential part to your children for any reason, ensure that they practise correct posture while using their devices. The height of the chair should be adjusted so that the laptop/tablet screen is at 15 degrees below their eye level. Looking up to the devices while lying down or sitting in a smaller chair will cause their eyelids to open wider which can lead to dry eyes. The digital screen should be at least 30-40cm away from their eyes. The device should be used under proper lighting, preferably natural light from the sun. If the screen glare is too strong, consider getting a blue light screen or filter that can reduce the level of blue light that can get into their eyes.

Annual Eye Examination

The American Optometric Association (AOA) has released a guideline for paediatric eye health. Research has provided evidence that supports the need of children ages 6 to 18 years to receive a comprehensive eye exam before entering school and annually thereafter. The recommended comprehensive eye exam has shifted from a two-year to a one-year frequency due to increased prevalence of eye and vision disorders.

And finally, look out for sign of eye problem in your child such as headaches, dry eyes, neck and shoulder pains, frequently rubbing their eyes, squinting while reading or watching television, or looking at object with chin raised or head tilted. Factors that could contributes to this are poor lighting, bad seating posture, excessive glare from the screen or simply fatigue. Further information on common children’s vision problem can be found in my first article: Children’s Vision. To find out more, do check out BFM Health & Living channel on the topic of Caring for Children’s Eyes, where I had the opportunity to share some insights at their BFM Health and Living Junior 2018 event on 2nd October 2018. You can download the podcast from the show at BFM website and can find the selected questions and answers from the interview on my next article. Finally, look out for the Bahasa Malaysia version of this article that will be published together in a companion piece.